摘要
目的评价单节段腰椎间盘突出症术后复发再次手术的远期疗效,并比较采用不同术式的远期结果。方法1998年2月-2003年2月,共行95例复发腰椎间盘突出症再手术,其中89例(93.7%)获随访并复习原始资料,76例符合研究纳入标准。男55例,女21例;年龄23～61岁,平均42岁。患者均有再次坐骨神经疼痛病史。复发时间8～130个月,平均69个月。位于L4、5节段48例,L5、S1间隙28例。再次手术分为3组,A组30例,单纯扩大开窗或双侧开窗髓核摘除术;B组24例,全椎板切除髓核摘除术;C组22例,全椎板切除髓核摘除360°融合内固定术。比较3组患者的临床治疗基本情况,采用临床功能评估标准进行临床疗效评估。结果A、B、C组术中出血量分别为(110.7±98.8)、(278.7±256.3)和(350.7±206.1)mL,手术时间分别为(65.9±22.8)、(111.6±24.3)和(127.3±26.7)min,术后住院时间分别为(6.7±1.4)、(10.2±1.8)和(12.2±2.3)d,B、C组与A组比较差异均有统计学意义(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。术后获随访36～96个月,平均86个月;A组(87.6±27.0)个月,B组(84.5±19.8)个月,C组(83.6±13.5)个月。3组的年龄、随访时间比较差异均无统计学意义(P>0.05)。3组总临床结果优良率80.3%,其中A组80.0%,B组79.2%,C组81.8%,3组比较差异无统计学意义(P>0.05)。随访结束时摄X线片示手术节段椎体不稳发生率,A组1例(3.3%),B组19例(79.2%),C组无。B组发生率高于A、C组,差异有统计学意义(P<0.05)。结论复发腰椎间盘突出症再次手术是必要的,单纯扩大开窗或双侧开窗髓核摘除术是较理想的方法。
Objective To assess long-term outcomes of reoperation for recurrent lumbar disc herniation, and to compare results of different methods, Methods There were 95 patients who had reoperation for recurrent lumbar disc herniation between February 1998 to February 2003, among whom a total of 89 （93.7%） were followed up and their primary data were reviewed. There were 76 patients, with the mean age of 42 years （range from 23 to 61）, who met the inclusion criteria and were included. Among them, there were 55 males and 21 females. All patients had the history of more than one sciatic nerve pain. The mean recurrent time was 69 months（range from 8 to 130 months）. There were 48 patients in L4,5 and 28 patients in L5, S1, of whom we chose 30 to undergo larger vertebral plate discectomy （or two-side fenestration） and nucleus pulpose discectomy （group A）, 24 to undergo the whole vertebral discectomy （group B） and 22 to undergo the whole vertebral discectomy and 360 degrees intervertebral fusion（group C）. The patients＇ cl inical results in the three groups were compared, and the clinical curative effects were evaluated by using clinical functional assessment standard. Results Clinical outcomes were excellent or good in 80.3% of the patients, including 80.0% of group A, 79.2% of group B and 81.8% of group C. There was no significant difference in each group （P 〉 0.05）. These three groups were not different in age, pain-free interval and follow-up duration （P 〉 0.05）. The mean intraoperative blood losses in the three groups were （110.7 ± 98.8）, （278.7 ± 256.3）, （350.7 ± 206.1） mL, respectively. The mean surgery time were （65.9 ± 22.8）, （111.6± 24.3）, （127.3 ± 26.7） minutes, respectively, and the mean hospitalization time were （6.7 ±1.4）, （10.2 ± 1.8）, （12.2 ±2.3） days, respectively. Group A was significantly less than group B or C （P 〈 0.05） and there was no significant difference between group B and C. All the patients were followed up for 36 to 96 months with an average of 86 months, and with （87.6 ± 27.0）, （84.5 ± 19.8）, （83.6 ± 13.5） months of group A, B and C, respectively. At the end of the follow-up, there were more cases of spinal instability at the same level in group B （19 patients） than in group A （1 patient） or group C （no patient） in X-ray, and the difference was significant （P 〈 0.05）. Conclusion Reoperation for recurrent lumbar disc herniation is effective, Larger vertebral plate discectomy or tow-side fenestration is recommended for managing recurrent lumbar disc herniation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第4期411-415,共5页
Chinese Journal of Reparative and Reconstructive Surgery
